Browsing by Author "Wilcox, James"

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    MSK PoCUS Training for Rural Clinics
    (2024-04-26) Smeltzer, Kathryn; Tollar, Roarke; Cook, Myanna; Wilcox, James; Ireland, Ellen
    INTRODUCTION: Point of care ultrasound (PoCUS) is a portable diagnostic technology with broad applicability, no radiation, and is less expensive than alternative imaging methods. PoCUS is emerging as high utility technology to expand bedside physical exams for primary care practitioners. Access to medical care in rural areas is an ongoing issue, especially for specialty care. By using PoCUS, rural providers may be able to more completely screen for conditions and determine if patients will need to seek specialty care, such as orthopedic intervention, which is often more time consuming for rural patients. OBJECTIVES: This study is to identify barriers to learning and using point of care ultrasound technology for rural primary care practitioners for expanded examination, including for orthopedic applications. The secondary objective of this pilot study is to evaluate the best practices of expanding rural PoCUS training. METHODS: The team identified six rural primary care practitioners at outpatient clinics around Indiana. Grant funding was used to equip these clinics with portable ultrasound probes with PoCUS-software-equipped iPads. Training consisted of approximately one hour of independent didactic material and two hours of in-person hands-on training with our investigators and students. Initial surveys were collected before and after the in-person training session. After a few months of individual practice, teleguidence training sessions were offered to the participants. Post-training surveys will be collected approximately six months after the initial training session. At this time, the first and second surveys for the six physicians have been analyzed and provide preliminary results. RESULTS: The pre-training survey from the six physicians before the in-person training session found that previous PoCUS experience of these physicians varies greatly, and nearly all of these practitioners have not used ultrasound in their clinic within the last year. This survey also showed unanimously that these physicians make orthopedic diagnoses in their practice but do not feel comfortable using ultrasound in supporting these diagnoses, showing the potential for PoCUS in their clinical practice. The second survey results have shown that even after just two hours of training, the physicians are comfortable with using ultrasound to support their orthopedic diagnoses, to the point that the majority are also somewhat comfortable teaching this material to others. All of the physicians agreed that the independent didactic material supplemented the in-person training, which supports both the quality and platforms provided for this material. The enthusiasm and improved confidence after the training sessions also support the quality of our investigators’ in-person training sessions. Though it was not difficult to recruit physician participants, one of the biggest obstacles this study faced was scheduling the in-person training session. CONCLUSION: Implementation of PoCUS in rural clinics for the evaluation of orthopedic diagnosis was met with enthusiasm and has shown potential for streamlining evaluation at specialty clinics. Major barriers to adopting this technology include finding adequate time for medical practitioners to learn and practice using the equipment and scheduling live, on-going training.
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    Point-of-Care Ultrasound in the Primary Care Office for Early Detection of Squamous Cell Carcinoma of the Supraglottic Larynx: A Case Report
    (Springer Nature, 2024-07-29) Wilcox, James; Kaefer, Samuel L.; Medicine, School of Medicine
    Point-of-care ultrasound (PoCUS) in the head and neck region is still in its early stages, despite decades of formal ultrasound use. A literature gap exists as recent studies primarily focus on general techniques, leaving room for exploration in ambulatory primary care, especially regarding neck masses. Our case demonstrates a 61-year-old female who presented for an annual wellness appointment, reporting a cough and alarming neck symptoms. A prompt investigation using PoCUS identified a suspicious neck mass. This mass was evaluated with bedside POCUS, and the mass was determined to be an abnormal lymph node with findings concerning malignancy. Subsequent diagnostic measures confirmed metastatic squamous cell carcinoma in the supraglottic larynx. This case underscores PoCUS's transformative potential in ambulatory primary care for neck mass evaluation, facilitating swift and thorough diagnostic processes. This successful outcome emphasizes PoCUS's promising role in routine clinical practice, urging future research for standardized evaluation protocols to enhance diagnostic efficiency.
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    Recommended Elements of a Musculoskeletal Course for Fourth-Year Medical Students: A Modified Delphi Consensus
    (Society of Teachers of Family Medicine, 2025) Knox, Jordan; Carek, Stephen; Cheerla, Rajalakshmi; Cochella, Susan; DeCastro, Alexei; Deck, Jason W.; DeStefano, Sherilyn; Hartmark-Hill, Jennifer; Petrizzi, Michael; Sepdham, Dan; Sulapas, Irvin; Wilcox, James; Wise, Matthew W.; Wu, Velyn; Medicine, School of Medicine
    Background and objectives: A recognized gap exists between primary care physicians' training in musculoskeletal (MSK) medicine and the burden of MSK complaints in primary care. Family medicine interns often lack adequate baseline MSK physical exam skills, which prompted a proposal to introduce a fourth-year preceptorship to reinforce MSK education. The aim of this study was to prioritize the most important elements to include in this new clinical rotation. Methods: We employed a three-round, modified Delphi method to derive consensus. Eleven panelists with experience and expertise in MSK training, medical education, or both generated a list of 118 elements. Each panelist then ranked each element by level of importance, and we reviewed the results. The ranking process was repeated two more times with a goal of achieving consensus. Results: Seventy-seven curricular elements (topics, skills, experiences) achieved consensus recommendation by being ranked either "fairly important" or "very important" for inclusion in the curriculum. Twenty-eight items were unanimously ranked "very important," 42 received a mix of "very important" and "fairly important" rankings, and seven received unanimous ranking of "fairly important." Three items were unanimously ranked "neither important nor unimportant." Conclusions: Longitudinal repetition of physical exam skills, reinforcement of relevant anatomy, and incorporation of specific frameworks for approaching MSK care are important components. Physical examination of the shoulder, knee, back, and hip are especially meaningful clinically.
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    Two-week intensive medical student point-of-care ultrasound training impact on long term utilization
    (Springer Nature, 2024-08-16) Herbert, Audrey; Russell, Frances M.; Ferre, Robinson M.; Wilcox, James; Peterson, Dina; Davis, Jean; Zakeri, Bita; Hays, Matthew; Wallach, Paul M.; Emergency Medicine, School of Medicine
    Background: There is little to no data evaluating long term usage of point of care ultrasound (POCUS) after a training intervention for medical students. The purpose of this study was to examine the impact of an intensive POCUS training program on medical student's usage at 9-months post-program. Methods: This was a prospective cross-sectional study of rising second year medical students who participated in a 2-week summer POCUS training program. Instruction consisted of 8 h of asynchronous online didactic material, 2-4 h of daily hands-on instructor-led and independent scanning, and instruction on how to teach POCUS. Students were assessed pre- and post-program, and again at 9 months post-program to evaluate POCUS usage. Results: A total of 56 students participated in the program over 2 summers; 52 (92.9%) responded to the 9-month post-program survey. At 9 months, 49 (94.2%) of students taught POCUS after the program to peers or faculty. Students reported serving as a POCUS instructor in 283 subsequent teaching sessions accounting for 849 h of POCUS instruction time. Six (11.5%) students were involved in the creation of a POCUS interest group on their regional campus, 7 (13%) created a POCUS curriculum for their student interest group, and 4 (7.7%) created an opt-in co-curricular POCUS program for students at their regional campus. Three (5.8%) students did not serve as educators after the program and only one student reported not using POCUS again after the program. Conclusion: After a 2-week intensive POCUS training program for medical students, the majority of students demonstrated continued involvement in POCUS learning and education at 9-month follow-up including serving as peer instructors and assisting with limitations in financial resources and trained faculty.
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    Use of Artificial Intelligence Program to Increase Resident Confidence and POCUS Use at the Bedside
    (2024-04-26) Wilcox, James; Lobo, Daniela; Hernandez, Reuben; Holley, Matthew; Renshaw, Scott
    Introduction: Point of Care Ultrasound (POCUS) education continues to increase in undergraduate and graduate medical education, mostly fueled by clinical usefulness and increasing graduate medical education requirements. Many schools are now teaching POCUS as a core part of the curriculum. However, with the sudden rush of POCUS education, one barrier often identified in the literature is a lack of trained faculty to educate residents and medical students. Study Objective: Our team at the Family Medicine Department recruited an artificial intelligence program developed by Global Ultrasound Institute to assist POCUS instructors with resident ultrasound education. The research project would use AI programming and learning to allow residents to access timely answers to questions at the bedside while on rounds, when a trained POCUS instructor might not always be present. Since POCUS instructors cannot be available for every bedside patient examination in the hospital or residency clinic, this AI program would provide answers to needed bedside questions to give residents more confidence with performing more POCUS evaluations. Methods: We would deploy the AI program for interns who have completed at least 6 months of POCUS training and residents who had completed prior intern POCUS training. This program would be available on smart phone devices for when rounding in adult medicine, pediatrics, OBGYN, and in the outpatient residency clinic. Residents will have 24/7 access to a smart AI who will answer questions about POCUS technique, indications for use, interpretation questions, and many more. The program will give residents a quick and focused answer, as well as access to resources for further study if needed. Resident POCUS use will be tracked with the Butterfly IQ academy, as well as with resident procedure logging. Results: Since this is a very new program and relationship with Global Ultrasound Institute, no results are currently available. We anticipate preliminary results will be available by the presentation date in April. Conclusions: Artificial Intelligence is changing the way medical education is approached in the United States and the world. This particular program will allow residents to have access to timely answers to their POCUS practice questions at the bedside, while on rounds. We anticipate this will allow residents the opportunity to use the ultrasound devices for more cases and scenarios, as well as have improved confidence in their ultrasound acquisition abilities, with the support of the AI Education Assistant.